Nephrologic Disorders and COVID-19: Difference between revisions

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To go to the COVID-19 project topics list, click '''[[COVID-19 Project Topics|here]]'''.
To go to the COVID-19 project topics list, click '''[[COVID-19 Project Topics|here]]'''.


{{CMG}} {{AE}} {{S.G.}} {{NN}}<br>
{{CMG}} {{AE}} {{S.G.}}  




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==Overview==
 
==Nephrologic_Disorders of COVID-19==
'''Complication 1: Acute Kidney Injury in COVID-19'''<br><br>
==Nephrologic_Disorders risk factors of COVID-19==
 
==Complications==
{{SK}} [[Acute Kidney Injury]], [[Acute Renal Failure]], [[AKI]], [[ARF]]
===AKI===
 
====Clinical Features of AKI by SARS-CoV-2====
==[[AKI overview|Overview]]==
====Treatment====
 
*[[COVID-19]] can involve many organs leading to organ failure, one of which is kidneys that manifest with mild [[proteinuria]] to advanced [[acute kidney injury]] ([[AKI]]).<ref name="pmid32416769">{{cite journal| author=Ronco C, Reis T, Husain-Syed F| title=Management of acute kidney injury in patients with COVID-19. | journal=Lancet Respir Med | year= 2020 | volume=  | issue=  | pages=  | pmid=32416769 | doi=10.1016/S2213-2600(20)30229-0 | pmc=7255232 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32416769  }} </ref>
 
 
 
=[[AKI pathophysiology|Pathophysiology]]=
 
*Angiotensin-converting enzyme 2 ([[ACE2]]), which is a primary receptor for [[SARS-CoV-2]] entry into cells, mostly presents in renal tubular epithelial cells as well as lungs and heart.<ref name="MalhaMueller2020">{{cite journal|last1=Malha|first1=Line|last2=Mueller|first2=Franco B.|last3=Pecker|first3=Mark S.|last4=Mann|first4=Samuel J.|last5=August|first5=Phyllis|last6=Feig|first6=Peter U.|title=COVID-19 and the Renin-Angiotensin System|journal=Kidney International Reports|volume=5|issue=5|year=2020|pages=563–565|issn=24680249|doi=10.1016/j.ekir.2020.03.024}}</ref>
*Despite kidney injury following [[COVID-19]] infection is less frequent than severe lung injury, [[ACE2]]: [[ACE]] ratio is higher in the kidneys compared to the respiratory system. (1:1 in the kidneys VS 1:20 in the respiratory system)<ref name="MalhaMueller2020">{{cite journal|last1=Malha|first1=Line|last2=Mueller|first2=Franco B.|last3=Pecker|first3=Mark S.|last4=Mann|first4=Samuel J.|last5=August|first5=Phyllis|last6=Feig|first6=Peter U.|title=COVID-19 and the Renin-Angiotensin System|journal=Kidney International Reports|volume=5|issue=5|year=2020|pages=563–565|issn=24680249|doi=10.1016/j.ekir.2020.03.024}}</ref>
* After [[SARS-CoV-2]] enters through the nasal cavity, it may travel to the kidneys and enters the bloodstream leading to severe inflammatory response activation and [[cytokine]] storm.
*It is thought that [[AKI]] following COVID-19 is the result of<ref name="MalhaMueller2020">{{cite journal|last1=Malha|first1=Line|last2=Mueller|first2=Franco B.|last3=Pecker|first3=Mark S.|last4=Mann|first4=Samuel J.|last5=August|first5=Phyllis|last6=Feig|first6=Peter U.|title=COVID-19 and the Renin-Angiotensin System|journal=Kidney International Reports|volume=5|issue=5|year=2020|pages=563–565|issn=24680249|doi=10.1016/j.ekir.2020.03.024}}</ref>
**[[Sepsis]] and [[cytokine]] storm
**[[Hypovolemia]] and Hypotension
**Hypoxemia
**Blood clots formation, leading to impaired blood flow in the renal arterioles.
*[[AKI]] is more likely to develop in the late stages of [[COVID-19]] in critically ill patients.<ref name="pmid32416769">{{cite journal| author=Ronco C, Reis T, Husain-Syed F| title=Management of acute kidney injury in patients with COVID-19. | journal=Lancet Respir Med | year= 2020 | volume=  | issue=  | pages=  | pmid=32416769 | doi=10.1016/S2213-2600(20)30229-0 | pmc=7255232 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32416769  }} </ref>
 
 
[[File:AKI physiopathology COVID.PNG|600px|center]]
 
 
 
=[[AKI Natural history|Natural history]]=
*[[AKI]] is frequently seen among patients with [[COVID-19]] hospitalized in [[ICU]], with prevalence of 0.6-29% in China {{cite web |url=https://www.esicm.org/blog/?p=2789 |title=Acute Kidney Injury in COVID-19 Patients &#124; COVID-19 |format= |work= |accessdate=}} and 22.2% in the USA.<ref name="pmid32320003">{{cite journal| author=Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW | display-authors=etal| title=Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. | journal=JAMA | year= 2020 | volume=  | issue=  | pages=  | pmid=32320003 | doi=10.1001/jama.2020.6775 | pmc=7177629 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32320003  }} </ref>
*While, the real incidence of [[AKI]] in critcally ill patients with [[COVID-19]] is estimated between 27-85%. {{cite web |url=https://www.esicm.org/blog/?p=2789 |title=Acute Kidney Injury in COVID-19 Patients &#124; COVID-19 |format= |work= |accessdate=}}
*Severe [[COVID-19]] pneumonia and [[severe acute respiratory distress syndrome]] are associated with developing [[AKI]].<ref name="PeiZhang2020">{{cite journal|last1=Pei|first1=Guangchang|last2=Zhang|first2=Zhiguo|last3=Peng|first3=Jing|last4=Liu|first4=Liu|last5=Zhang|first5=Chunxiu|last6=Yu|first6=Chong|last7=Ma|first7=Zufu|last8=Huang|first8=Yi|last9=Liu|first9=Wei|last10=Yao|first10=Ying|last11=Zeng|first11=Rui|last12=Xu|first12=Gang|title=Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia|journal=Journal of the American Society of Nephrology|volume=31|issue=6|year=2020|pages=1157–1165|issn=1046-6673|doi=10.1681/ASN.2020030276}}</ref>
*Approximately half of the new AKI cases following COVID-19 is mild with good short-term prognosis.
*If no improvement occurs during follow-up, it is contributed to higher mortality.<ref name="PeiZhang2020">{{cite journal|last1=Pei|first1=Guangchang|last2=Zhang|first2=Zhiguo|last3=Peng|first3=Jing|last4=Liu|first4=Liu|last5=Zhang|first5=Chunxiu|last6=Yu|first6=Chong|last7=Ma|first7=Zufu|last8=Huang|first8=Yi|last9=Liu|first9=Wei|last10=Yao|first10=Ying|last11=Zeng|first11=Rui|last12=Xu|first12=Gang|title=Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia|journal=Journal of the American Society of Nephrology|volume=31|issue=6|year=2020|pages=1157–1165|issn=1046-6673|doi=10.1681/ASN.2020030276}}</ref>
*Early diagnosis and treatment of [[AKI]] in patients with [[COVID-19]] can avoid the progression of [[AKI]] into [[ESRD]] and reduce mortality.<ref name="pmid32416769">{{cite journal| author=Ronco C, Reis T, Husain-Syed F| title=Management of acute kidney injury in patients with COVID-19. | journal=Lancet Respir Med | year= 2020 | volume=  | issue=  | pages=  | pmid=32416769 | doi=10.1016/S2213-2600(20)30229-0 | pmc=7255232 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32416769  }} </ref>
=[[AKI History and Symptoms|History and Symptoms]]=
 
*Patients in the early stages of kidney failure may be asymptomatic. If left untreated, patients may progress to develop [[Azotemia]] and [[Uremia]], which occur due to the buildup of waste materials in the blood.
'''History and Symptoms'''
*Symptoms of kidney injury include<ref name=Skorecki>{{cite book |vauthors=Skorecki K, Green J, Brenner BM |veditors=Kasper DL, Braunwald E, Fauci AS |title=Harrison's Principles of Internal Medicine|url=https://archive.org/details/harrisonsprincip00kasp |url-access=limited |edition=16th |year=2005 |publisher=McGraw-Hill |location=New York, NY |isbn=978-0-07-139140-5 |pages=[https://archive.org/details/harrisonsprincip00kasp/page/n1681 1653]–63 |chapter=Chronic renal failure|display-editors=etal}}</ref>:
**Nausea and Vomiting
**Weakness
**Fatigue
**Confusion
**Weight loss
**Loss of appetite
** Decrease in urine output:[[Oliguria]] or [[Anuria]]
**Fluid retention, leading [[edema]] and swelling of face, extremities
**Electrolyte imbalance; High level of [[Potassium]] which leads to [[cardiac arrhythmia]]
 
'''Physical Examination'''
*[[Hypotension]]
*Peripheral [[edema]]
*Rales in lungs examination
=[[AKI Diagnosis|Diagnosis]]=
 
'''Laboratory Findings'''
*Laboratory findings consistent with the diagnosis of [[AKI]] include:
**Elevated [[BUN]] level
***Plasma BUN-creatinine ratio> 20 in prerenal [[AKI]]
***Plasma BUN-creatinine ratio< 15 in intrinsic [[AKI]] or [[Acute Tubular Necrosis]]
**Based on KDIGO definition for the diagnosis of [[AKI]]<ref name="pmid22890468">{{cite journal| author=Khwaja A| title=KDIGO clinical practice guidelines for acute kidney injury. | journal=Nephron Clin Pract | year= 2012 | volume= 120 | issue= 4 | pages= c179-84 | pmid=22890468 | doi=10.1159/000339789 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22890468  }} </ref>:
***Elevated serum Creatinine by ≥0.3 mg/dl (≥26.5 μmol/l) within 48 hours; or
***Elevated serum Creatinine to ≥1.5 times baseline within the previous 7 days; or
***Urine volume < 0.5 ml/kg/h for >6 hours
**Fractional excretion of sodium ([[FENa]])
***([[FENa]])< 1% in prerenal [[AKI]]
***([[FENa]])> 2% in intrinsic [[AKI]] or [[Acute Tubular Necrosis]]
**Urinary sediment
***Hyaline casts in prerenal [[AKI]]
***Granular or Muddy brown casts in intrinsic [[AKI]] or [[Acute Tubular Necrosis]]
'''Electrocardiogram'''
*There are no specific ECG findings associated with AKI. However, electrolyte disturbances such as hyperkalemia might lead to various ECG findings.
 
'''Ultrasound Finding'''
 
'''Other Diagnostic Studies'''
 
=Treatment=
 
*Management of [[AKI]] following [[COVID-19]] includes treatment of infection, identifying electrolyte disorders, and [[intravenous fluid]] administration.
 
'''AKI Medical Therapy'''
*Treatment of [[AKI]] following [[COVID-19]] includes<ref name="pmid32416769">{{cite journal| author=Ronco C, Reis T, Husain-Syed F| title=Management of acute kidney injury in patients with COVID-19. | journal=Lancet Respir Med | year= 2020 | volume=  | issue=  | pages=  | pmid=32416769 | doi=10.1016/S2213-2600(20)30229-0 | pmc=7255232 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32416769  }} </ref>:
**Correction of hypovolemia and hypotension by the administration of adequate [[intravenous fluid]]
**Correction of electrolyte disturbances
**[[Renal Replacement Therapy]]
***If AKI is unresponsive to conservative therapy
***In volume overload conditions
***Modality of choice in unstable hemodynamic status and [[ESRD]]
**Anticoagulants in hypercoagulable conditions
**Sequential extracorporeal therapy
==References==
{{Reflist|2}}
 
[[Category:Disease]]
[[Category:Emergency medicine]]
[[Category:Kidney diseases]]
[[Category:Nephrology]]

Revision as of 02:43, 22 June 2020

To go to the COVID-19 project topics list, click here.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2]


Overview

Nephrologic_Disorders of COVID-19

Nephrologic_Disorders risk factors of COVID-19

Complications

AKI

Clinical Features of AKI by SARS-CoV-2

Treatment

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